POP Repeat Prescription Florey Content

Hi/Dear NAME,

To prescribe the medication that you have requested, I would like you to provide some information about your health. Please use the link below to submit this.

Thanks, SIGN OFF

Please follow this link: (link will autogenerate here)

You'll need internet on your phone (or you can open the link on a computer). If you cannot open it, please contact us.


First Page of Questionnaire


To prescribe the medication that you have requested, your practice needs you to answer some questions about your health. It should take no longer than five minutes to complete the questionnaire.

Are you happy to proceed?

Powered by accuRx.


What is your date of birth?

Example 8 12 1988


Do you know the name of the contraceptive pill you want?

  • Yes

  • No

  • No, but I want the same one I was given last time

If Yes:

What is the name of the contraceptive pill you are requesting a repeat prescription for?

  • Type your answer here

If No/No, but I want the same one I was given last time and when they have answered the last question for yes.

Have you been diagnosed with any new health conditions since we last issued you a prescription for the Pill?

These could be any conditions but in particular: heart disease, stroke, breast cancer, liver disease.

  • Yes

  • No

If Yes:

What new health conditions have you been diagnosed with since your last prescription?

  • Type your answer here

If No and after answering the questions asked if yes to new conditions:

Have you experienced any changes to your bleeding pattern that are worrying you (such as unexpected spotting, or after sex)?

  • Yes

  • No

If Yes:

Are you up-to-date with your cervical screening (smear test)?

  • Yes

  • No

Are you interested in having any sexual health screening?

This could be important as the oral contraceptive pill does not protect against sexually transmitted infections.

  • Yes

  • No

What is your current smoker status?

  • Current Smoker

  • Ex-smoker

  • Never smoked

If a current smoker:

How much do you smoke a?

  • <1 cigarette or equivalent per day

  • 1-9 cigarettes or equivalent per day

  • 10-19 cigarettes or equivalent per day

  • 20-39 cigarettes or equivalent per day

  • 40+ cigarettes or equivalent per day

After answering how much they smoke or if they are an ex-smoker or have never smoked they will be asked:

Are you able to provide a blood pressure reading?

To safely prescribe the contraceptive pill, it is important that we have an up-to-date blood pressure reading.

  • Yes

  • No

If yes if provides the following information:

Before you take your blood pressure reading:

  • Sit down comfortably for 5 minutes.

  • Wear loose-fitting clothing

  • Make sure your arm is around the same level as your heart

  • Make sure your arm is relaxed

When taking your blood pressure:

  • Put the cuff on following the instructions which came with your blood pressure monitor.

  • Keep still and silent.

Other Tips:

  • Take at least three readings, each two minutes apart.

  • Your first reading may be much higher than the next readings. If this is the case, keep taking readings until they level out and stop falling. Use this as your reading.

Please seek urgent medical attention if you develop any of the following:

  • Blood pressure is 170/115 or above (despite repeating it at least 2 times)

  • Chest pain

  • Changes in vision

  • Confusion

  • Severe headache

If you want more tips or to learn more, see the British Heart Foundation website.

Please enter your systolic (SYS) blood pressure reading. This is the top reading.

  • Answer

Please enter the diastolic (DIA) blood pressure reading. This is the lower reading. Note: This is not the pulse.

  • Answer

Do you know your weight?

  • Yes (Will be asked to provide weight in kilograms)

  • No

Do you know your height?

  • Yes (Will be asked for height in centimeters)

  • No

Is there anything else regarding the contraceptive pill that you would like us to know?

  • Type your answer here

After completing the questionnaire the patient will be asked :

Are you happy with these answer

  • Given a list of all their answers.

If they are happy they can select 'Submit'.

After pressing 'Submit':

Thank you for submitting your answers.

What next?

A clinician will review the answer and you will receive a contact in the next 5 working days to let you know the outcome of your prescription request/pill review.

Please make sure you read this information paying particular attention to:

  • Possible disadvantages/side-effects of the pill

  • Risks of the pill and when to seek medical advice

  • What to do if you forget to take the pill

  • What to do if you vomit or have diarrhea

  • Effects of other medicines on the pill

  • When you might need emergency contraception

Long-acting reversible contraception.

If you are interested in switching from the daily pill to a long-acting contraceptive (such as the coil, implants, injections) you can find more information on these here. Contact the practice if you would like to discuss this further.

Smoking cessation advice (If a current smoker)

Smoking leads to health problems such as cancer, heart disease and strokes. The benefits of stopping smoking include: better health, more money and cleaner air for those around you!

Do you want to stop smoking? Here is some advice on ways to quit smoking, local services and general tips: nhs.uk/smokefree

After completion SMS:

Thank you for submitting your answers, we will be in touch regarding this within 5 working days.

Response team in accuRx Inbox:


@POP Patient NAME has responded:


Knows the name of pill:

New health conditions:

New medications/supplements:

Changes to PV bleeding:

Thinks up-to-date with smear:

Wants sexual health screening:

Smoking status:

Smoking quantity:

Anything else:

The following codes are also saved according to the patient's response:

"What is your smoking status?"

  • "Current smoker" - Current smoker

  • "Ex-smoker" - Ex-smoker

  • "Never smoked" - Never smoked

[if chose 'Current Smoker' above]
Smoking: "How much do you smoke?"

  • "Trivial smoker (<1 cigarettes/day or equivalent)" - Trivial smoker (<1 cigarettes/day or equivalent)

  • "Light smoker (1-9 cigarettes/day or equivalent)" - Light smoker (1-9 cigarettes/day or equivalent)

  • "Moderate smoker (10-19 cigarettes/day or equivalent)" - Moderate smoker (10-19 cigarettes/day or equivalent)

  • "Heavy smoker (20-30 cigarettes/day or equivalent)" - Heavy smoker (20-30 cigarettes/day or equivalent)

  • "Very heavy smoker (40+ cigarettes/day or equivalent)" - Very heavy smoker (40+ cigarettes/day or equivalent)

Smoking cessation advice given - This code is added for anyone who says they are a current smoker. We display a standard short bit of smoking cessation advice with link to nhs.uk/smokefree.

  • Systolic arterial pressure - 72313002

  • Diastolic arterial pressure - 1091811000000102

  • Weight - 162763007

  • Height - 162755006

  • BMI - 60621009

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